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Hospitals Face Higher Costs, More ED Visits from Opioid Abuse

The rates of inpatient stays and emergency department visits related to opioid abuse are skyrocketing, AHRQ says in a new public health data brief.

December 21, 2016 - Opioid abuse has quickly become one of the nation’s most pressing population health management issues, not only because of its toll on patients, but increasingly because of the financial impact on hospitals and the rest of the healthcare system.

New data from the Agency for Healthcare Quality and Research shows a rapid increase in hospitalizations related to opioid misuse since 2000, and a commensurate rise in overdose deaths.

Between the start of the century and the year 2014, opioid-related death rates increased by 200 percent. Fourteen percent of that increase occurred between 2013 and 2014.

Adult hospitalizations due to opioid misuse or dependence doubled from 2000 to 2012. From 2005 to 2014, emergency department visits exhibited a 99.4 percent cumulative increase.

This data should be extremely alarming, says Andy Bindman, MD, Director of the AHRQ, and addressing the precipitous rise in recreational opioid use and the unintentional formation of dependence on painkillers has become a top federal priority.

“Having been a primary care physician who practiced in a safety-net setting, I’m very familiar with patients who use opioids. These drugs are remarkable in their ability to block the sensation of pain, which comes in handy after surgery or an injury,” Bindman wrote in a blog post earlier in December.

“However, chronic use of these medications or misuse of them for recreational purposes can lead to significant functional impairments, serious health complications, and even death. The increasing availability of these drugs inside and outside of the health care system is contributing to an epidemic that can be devastating for patients and their families.”

Opioids are also draining billions of dollars from the healthcare system. Matrix Global Advisors estimates that back in 2007, the financial burden of opioid abuse was around $25 billion. An 8 percent annual increase in emergency department visits and a 5.7 percent year-by-year increase in inpatient stays is likely to push that number significantly upward.

The data indicates marked state-by-state differences in the rates of opioid misuse and subsequent health system utilization. In 2014, opioid-related inpatient stays were highest in Maryland, Washington DC, New York, Rhode Island, and Massachusetts. Maryland saw 362.1 admissions per 100,000 residents, which is significantly above the national average of 224.6.

In contrast, Iowa and Nebraska had admission rates of 44.2 and 46.1 respectively. Georgia, South Dakota, Wyoming, Kansas, and Texas all had rates below 100 admissions per 100,000 patients.

Kansas also saw the greatest reduction in admissions between 2009 and 2014, slashing hospital stays by more than ten percent. And despite its position at the top of the inpatient utilization chart, Maryland has actually cut its hospital usage significantly. The state has seen a 9.2 percent decline in opioid-related inpatient stays since 2009.

However, all but four states recorded increases in opioid hospitalizations. In Oregon and North Carolina, hospital stays for opioid issues rose by more than 80 percent during that time period.

Emergency department visits followed similar patterns, with Massachusetts, Rhode Island, and Maryland at the top of the list for opioid-related ED visits and Nebraska and Iowa at the bottom. While the national average was 177.7 per 100,000 residents, Massachusetts saw an astonishing 441.6 ED visits per 100,000 in 2014 – more than 150 more than the next state on the list.

Iowa was the only state to see a decrease in ED usage between 2009 and 2014, showing an 18.5 percent reduction in emergency visits. Ohio topped the list, increasing its emergency department use by 119.1 percent during those five years.

The data doesn’t say anything that hospitals don’t already know, acknowledged Bindman, but the breakdown can produce a more granular image of the problem that can inform future policy decisions.

“State-specific opioid data can help us understand where the burdens on hospital care have grown the most,” he said. “They may also suggest which states are making the most headway when it comes to tackling the epidemic.

“Gaining a greater understanding of the trends is just one element of a strong Federal push to reduce opioid misuse. HHS initiatives focus on three areas: opioid prescribing practices to reduce opioid disorders and overdose; expanded use of naloxone to treat overdoses; and expanded use of medication-assisted treatment to reduce opioid use disorders and overdose.”

In 2015, AHRQ made $12 million in grant funding available to examine how to best deliver medication-assisted treatment for opioids in rural communities. And the 21st Century Cures Act, recently signed into law, will allocate $1 billion in funding to fight opioid misuse across the country.

Surgeon General Vivek H. Murthy, MD, MBA, who released a landmark report on substance abuse earlier in 2016, is also encouraging a national effort to reduce the negative health impacts of addiction. In November, Murthy encouraged stakeholders from across the care continuum to pledge their problem-solving powers to generating innovative solutions to the growing opioid crisis.

Increased local oversight of controlled substance prescribing through state prescription drug monitoring programs (PDMPs), as well as the implementation of electronic monitoring systems in almost every state, are also helping to reduce the prevalence of opioids in the community.

Better integration of pharmacy benefit claims and electronic health record data, the widespread adoption of e-prescribing tools, and individual state efforts such as electronic prescribing laws in Maine and New York may further the push to curb the availability of painkillers.

“Patients can’t alter [electronic prescriptions] like they sometimes would alter handwritten prescriptions,” said Ken Whittemore, SVP of Professional and Regulatory Affairs at Surescripts, to EHRintelligence.com when discussing the New York law. “And you don’t have the issues associated with people stealing the official New York State prescription blanks and using them to write bogus prescriptions.”

“In addition, because electronic prescribing gives providers access to patient medication histories, they also have that additional data source that they can see what other medications have been prescribed for a patient and by whom.”

These health IT-driven actions may help to reduce the number of patients “doctor shopping” for controlled substances and prevent unintentionally duplicated prescriptions while simultaneously allowing providers to gain better insights into the socioeconomic and behavioral health challenges underpinning the development of opioid abuse.

“I know solving this problem will not be easy,” said Murthy in an open letter to providers accompanying his report. “We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.”